ABA Cardiac Anesth key terms

The heart's ability to increase contractile force as ventricular filling volume rises, within physiologic limits. It explains why stroke volume usually grows with greater preload, and why excessive filling produces congestion without further useful output.

The tension within the ventricular wall needed to generate pressure. It increases with higher intracavitary pressure and larger chamber radius, and decreases with greater wall thickness, linking afterload to myocardial oxygen demand and hypertrophy.

The gradient driving blood through coronary arteries, approximated as aortic diastolic pressure minus left ventricular end-diastolic pressure. Tachycardia and high filling pressures lower it, and the subendocardium is most vulnerable to ischemia.

Impaired relaxation or increased chamber stiffness that raises filling pressures at any given volume. Affected patients depend on atrial contraction and decompensate with tachycardia, fluid overload, or loss of sinus rhythm.

The resistance to blood flow across the pulmonary circulation, normally very low. It rises with hypoxia, acidosis, hypercapnia, and vasoconstrictor drugs; a high value strains the right ventricle and can precipitate right heart failure.

The total oxygen transported to tissues each minute, calculated as cardiac output multiplied by arterial oxygen content. It integrates pump function, hemoglobin, and oxygenation; when delivery falls below tissue demand, anaerobic metabolism and organ injury follow.

A multivariable model estimating operative mortality and major morbidity for cardiac surgery from patient and procedural variables. It supports shared decision-making, benchmarking, and case-mix adjustment, and is periodically recalibrated as practice changes.

A European multivariable model predicting in-hospital death after cardiac surgery using patient, cardiac, and operative factors. It is used for consent discussions and quality comparison, but may misestimate risk in specific subgroups such as emergent or complex cases.

A syndrome of reduced physiologic reserve, marked by weakness, slow gait, low activity, and unintentional weight loss, that predicts complications, prolonged recovery, and death after cardiac surgery better than age alone. Screening helps tailor goals of care.

Planned withdrawal of aspirin plus a P2Y12 inhibitor before surgery to limit bleeding while avoiding stent thrombosis. Safe timing depends on stent type and drug half-life, and decisions are usually made jointly with the interventional cardiologist.

A coordinated strategy to diagnose and treat anemia, minimize blood loss, and transfuse only when indicated. In cardiac surgery it reduces transfusion rates, infection, and renal injury while improving outcomes and conserving scarce blood products.

A flow-directed catheter that measures right heart and pulmonary artery pressures, estimates cardiac output by thermodilution, and permits sampling of mixed venous blood. Risks include arrhythmia, infection, and pulmonary artery perforation.

The breath-to-breath percentage change in stroke volume during positive-pressure ventilation. A high value in a fully ventilated, stable patient suggests preload responsiveness, but arrhythmia, spontaneous breathing, and small tidal volumes make it unreliable.

Ultrasound imaging of the heart from a probe placed in the esophagus, giving real-time views of valves, chambers, and aorta. During cardiac anesthesia it guides cannulation, assesses ventricular function, detects regional wall motion abnormalities, and evaluates surgical results.

A near-infrared spectroscopy reading of regional frontal lobe oxygen saturation that reflects the balance between cerebral blood flow and oxygen use. Trends help detect desaturation during aortic or carotid manipulation and guide blood pressure and perfusion targets.

The oxygen saturation of blood in the pulmonary artery, reflecting the whole-body balance between oxygen delivery and consumption. A low value suggests inadequate output, anemia, or high demand; a high value may indicate sepsis or shunting.

A cold or blood-based solution delivered into the coronary circulation to arrest the heart and protect myocardium during cardiopulmonary bypass. Its electrolyte, buffer, oxygen, and additive composition determines the safety and duration of the arrest.

A bedside whole-blood clotting test used to confirm that heparin provides adequate anticoagulation for cardiopulmonary bypass and to guide supplemental heparin dosing. It is less precise than laboratory assays and is influenced by hemodilution, hypothermia, and platelet function.

An antibody-mediated reaction to heparin that paradoxically causes thrombosis and a falling platelet count, typically five to ten days after exposure. Management replaces heparin with a non-heparin anticoagulant and strictly avoids further heparin exposure.

A balloon positioned in the descending aorta that inflates in diastole and deflates in systole, raising coronary and cerebral perfusion pressure while reducing afterload and myocardial work. It needs a stable native rhythm and is inappropriate with significant aortic regurgitation.

Extracorporeal support in which blood is drained from a vein, oxygenated, and returned to the arterial circulation, providing both respiratory and hemodynamic support. It is used for cardiogenic shock and refractory cardiac arrest, with risks of bleeding, stroke, and limb ischemia.

An implanted pump that draws blood from the left ventricle and ejects it continuously into the aorta without a pulse. Recipients often have no palpable pulse; management targets volume status, pump speed, and anticoagulation, and right heart failure is a frequent complication.

An adverse response to protamine given to reverse heparin, ranging from mild hypotension and rash to bronchospasm or catastrophic pulmonary vasoconstriction with right ventricular failure. Risk is higher after prior exposure, vasectomy, or fish allergy.

Persistent hypotension with low systemic vascular resistance and normal or high cardiac output after cardiopulmonary bypass, poorly responsive to fluids. Treatment uses vasopressors, and refractory cases may receive vasopressin, methylene blue, or hydroxocobalamin.

A common supraventricular arrhythmia after cardiac surgery that increases stroke risk, prolongs hospital stay, and raises cost. Care emphasizes rate or rhythm control, electrolyte normalization, and anticoagulation when indicated; prophylactic beta-blockers reduce its incidence.

Planned early removal of the tracheal tube, often within hours of surgery, using short-acting anesthetics, full rewarming, and standardized criteria. It reduces ventilator-associated harm and length of stay but demands strict readiness assessment.

An acute, fluctuating disturbance of attention and awareness in critically ill patients, frequently hypoactive and easily missed. Risk rises with older age, benzodiazepines, sleep disruption, and inflammation; prevention stresses orientation, early mobilization, and avoiding deliriogenic drugs.

A multidisciplinary bundle of evidence-based perioperative practices, including nutrition optimization, opioid-sparing analgesia, early extubation, and early mobilization, applied to cardiac surgical patients. The goal is shorter stay and fewer complications without compromising safety.

A postoperative decline in renal function driven by ischemia, inflammation, hemolysis, and nephrotoxins, usually appearing within the first days. Creatinine lags behind injury, so urine output and biomarkers matter; severe cases require renal replacement therapy.

A staged surgical arrangement in which systemic venous blood flows directly into the pulmonary arteries without a ventricular pump. Pulmonary blood flow depends on passive pressure gradients, so these patients are sensitive to airway pressure, pulmonary resistance, and ventricular dysfunction.

Congenital anatomy in which one functional ventricle supplies both the systemic and pulmonary circulations, usually after staged palliation. Anesthetic management targets balanced pulmonary and systemic blood flow, adequate mixing, and protection of ventricular function.

Techniques such as double-lumen tubes or bronchial blockers that collapse one lung to improve surgical exposure in thoracic and some cardiac procedures. Position is confirmed by fiberoptic bronchoscopy; hypoxemia and tube malposition are frequent problems.

Severe early failure of a transplanted heart or lung without an identifiable technical or immunologic cause. It presents with hypotension, low output, or hypoxemia soon after implantation and may require inotropes, inhaled nitric oxide, or extracorporeal support.

A heart lacking sympathetic and parasympathetic innervation after transplantation. It beats at an intrinsic resting rate, responds slowly and blunted to circulating catecholamines, and does not react to atropine or vagal maneuvers.

A structured verbal exchange before incision confirming patient identity, procedure, allergies, imaging, antibiotic prophylaxis, and anticipated critical events. Consistent use improves team communication and reduces wrong-site errors and preventable harm.

Team training using aviation-derived behaviors such as clear role assignment, closed-loop communication, speaking up, and pre-case briefings to reduce human error in high-stakes environments like the cardiac operating room and intensive care unit.

A standardized transfer of care following a fixed sequence, for example illness severity, patient summary, actions taken, situation awareness, and contingency planning, so the receiving clinician obtains complete, prioritized information and can ask clarifying questions.